Lessons from Innovations in Orthobiologics
- jtomkin3
- 5 days ago
- 4 min read
Updated: 2 days ago
MD Biologix recently hosted the Innovations in Orthobiologics Lunch Symposium, the first in what will be an annual event in the Canadian sports medicine calendar. Led by Dr. Nathan Thakur at Regenerative MD alongside Dr. Kaila Holtz, Dr. Marni Wesner and Dr Grant Pagdin, the day brought together Canadian experts to share their experience using orthobiologics.
How do we move in this “minefield of variables”, towards one defined by standardization? Across platelet-rich plasma (PRP), hyaluronic acid (HA), and emerging biologics, the Symposium served to paint a clear picture from where we began to where we’re headed, while addressing the needs of physicians and patients today.
Key Clinical Takeaways
PRP is defined as ≥1 million platelets/µL (~5× baseline), anything less is not PRP
10 billion platelets has been recognized by the AAPM&R as the minimum therapeutic threshold for outcomes in knee OA
PRP+ HA combination therapy is the gold standard for joint pathology, lowering inflammatory markers for up to a year
Future direction is shifting towards condition-specific dosing and standardized protocols
View the Full Symposium: Innovations in Orthobiologics
Where We Were
Historically, musculoskeletal care followed a predictable path: patient presents with pain → conservative care and NSAIDs → symptom recurrence → surgery. Orthobiologics existed at the periphery as an emerging and promising field, but one defined by disparity.
PRP outcomes were notoriously variable, often hovering around the minimal clinical difference. A Mayo Clinic analysis of 33 commercially available PRP systems found only 11 met the minimum standard, while 3 systems actually produced final products with platelet counts lower than whole blood. The problem wasn’t the biology, it was the absence of a shared definition of what PRP actually is.
The infamous RESTORE trial, frequently cited as evidence against PRP in knee OA, used a 1.5–3× baseline concentration which doesn't meet the definition of PRP. Rather, it served to prove that under-dosed PRP is ineffective, setting the groundwork for future studies to define what PRP actually is.
Where We Are
Today, PRP has been quantified as having a minimum threshold of 1 million platelets/µL (around 5× baseline). Furthermore, consensus on the primary driver for outcomes has shifted from concentration to dose-dependence – with 10 billion platelets being recognized by the AAPM&R as the minimum therapeutic threshold for outcomes in knee OA.
Evidence has increasingly supported individualized treatment protocols per indication, emphasizing response-based decision-making rather than rigid scheduling, with no demonstrated downside to injection frequency.
PRP and HA are no longer viewed as competing therapies but the gold standard of treatment for joint pathologies. Producing a synergistic effect by modulating inflammatory markers in the joint for up to a year.
Clinical consensus has continued to segment PRP composition for targets. As Dr. Wesner put it “Joints don't like to be inflamed, so leukocyte-poor for joints. Soft tissue needs the inflammatory cascade for healing, so leukocyte-rich for tendons”. And ultrasound guidance is no longer an option, but essential for intra-substance injections.
Where We're Going
Three clear trends are shaping the next phase of orthobiologics:
Dose Precision and Protocol Specificity
Future protocols will move beyond a one-size-fits-all approach towards indication-specific protocols, with defined dosage based on injection route, pathology, and severity.
Expanded Indications
Advanced applications are moving into clinical practice which include: intra-osseous PRP for subchondral pathology, perineural and intraneural applications, and PRP as a biologic scaffold or “glue”.
Cellular Therapies
Early clinical data combining PRP with lipoaspirate or bone marrow aspirate shows sustained functional improvement in a significant proportion of patients beyond two years. Parallel research in allogeneic MSCs has demonstrated MRI-confirmed structural improvements, signaling a shift from symptomatic control, toward true disease modifying treatment.
Addressing Real-World Challenges
Adopting orthobiologics in practice can be quite challenging, as there’s a lot of front-loading needed before treating patients. In the words of Dr. Thakur “start with knees only”, mastering the most rudimentary injection before undertaking soft tissue pathologies. Furthermore, taking ultrasound guided injection courses, and shadowing experienced clinicians goes a long way.
Kit selection has become increasingly critical, as outcomes are tied to system performance and reproducibility. In the words of Dr. Wesner “the bang for the buck is in the platelets”. Choosing a validated commercial system that can reliably deliver a therapeutic dose is the first step to standardizing protocols.
For many Canadians, PRP remains largely out-of-pocket. However, the landscape is shifting. Third-party regional insurers like ICBC and WorkSafe BC have begun covering PRP for eligible patients via pre-authorization letters, and patients with health spending accounts can also redirect those funds toward treatment. Furthermore, certain regional clinics are exploring pricing models closer to cost and patient payment plans to expand access.
Looking Ahead
The Innovations in Orthobiologics Symposium will return next year, and at the current pace of change, the conversation will continue to evolve quickly. What was uncertain just a few years ago: dose thresholds, combination therapy, system variability, is now becoming standardized clinical practice.
MD Biologix is proud to support this shift toward evidence-based, standardized care, and to continue contributing to the clinical education and infrastructure that make it possible.
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